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CHAPTER VIII.

INFLAMMATORY DYSPEPSIA.

INFLAMMATION is a term that has been applied to certain associated symptoms of disease; but the unfounded hypotheses that have been made in connexion with it. have led to so much misapprehension that we would gladly renounce the word altogether; we feel, however, that it has become so interwoven with medical phraseology, that it is almost impossible to substitute any other term.

When inflammatory action arises in any form, the whole of the structural character of the part affected is altered, as indicated by the modified circulation and character of the blood, by change in the nervous system, by the condition of the solid structure, and still more by the functions of the organ being interfered with. Thus redness and preternatural heat are excited at the part affected, the sensibility is increased, the structure of the tissues become swollen from the effusion of sero-albuminous or fibrinous products, and the functional energy is lessened. For instance, in inflammation of the stomach every part is changed; the capillary arteries become

surcharged with blood, and if the disease be severe and acute, active hyperæmia gives place to one of comparative stagnation of blood; the mucous membrane acquires such increased sensibility, that the presence of anything in the viscus causes pain and vomiting; the membranes of the stomach are all thickened, especially when the morbid process has continued for a considerable time, and the function of the organ is more or less checked, for the stomach is unable to dissolve nitrogenous substances, and to form chymous fluid.

It is not only in severe disease that these indications of abnormal action exist; but even in acute dyspepsia the same changes are apparent, although differing in degree; and the remarkable opportunity Dr. Beaumont had of witnessing the interior of the stomach in Alexis St. Martin has elucidated facts of peculiar interest; thus he saw through an opening in the side the effects produced by ardent spirits upon the mucous membrane ; erythematous inflammation was at once set up, and the surface of the stomach became preternaturally red and congested, and also drier than in health, shewing that the gastric juice was not properly secreted. These changes were transient; but when irritation is persistent, an oedematous state of the membrane from serous effusion is followed by true thickening from fibrinous product; the surface becomes mamillated, and the cellular tissue is rendered more dense and opaque.

The lining membrane of the mouth and of the œsophagus secrete an alkaline fluid, which is increased in quantity by the additions from the large salivary glands. The purposes served by the saliva are not only to facilitate mastication and deglutition, but it has also a truly digestive function, and on this account we are led to notice it more particularly. A peculiar principle is present in saliva to which the term ptyalin has been given, and it has the property of converting the particles of starch into dextrin and into sugar; saline ingredients are also present, soda, potash, and lime, combined with phosphoric acid, with some lactic acid, and with a variable quantity of sulpho-cyanogen. It is from these saline substances that an alkaline reaction is obtained, and the alkalinity is more apparent during active mastication; but a fact of greater importance in the consideration of indigestion is, that the saliva loses its alkaline and acquires an acid reaction during irritable states of the alimentary canal, and the organic principle ptyalin, always prone to decomposition of a putrefactive kind, is during disease more readily changed, and the breath thus acquires a faint and sickly character. Imperfect mastication, therefore, and insufficient salivary reaction, as well as a variable quantity of saline ingredients transmitted to the stomach, have each a causative relation with indigestion. Still more important are the secretions from the lining membrane of the stomach; in addition to the ordinary secretion from the mucous

membrane, minute glands pour out a fluid which is essentially digestive in its properties, and which is known by the name of the gastric juice. These secretions are changed in inflammatory dyspepsia; the inner surface of the stomach becomes drier than natural, and the power of solution of food is diminished, or altogether checked; when the stomach is inactive, and no digestion going on, the reaction by test paper may be neutral or even alkaline, but when active solution of food is in progress, the fluid formed is always acid. The gastric juice is a clear watery fluid, acid, but containing a considerable quantity of saline material. The acid consists principally of hydrochloric acid, probably derived from chloride of sodium, and lactic acid is generally also present; but an equally essential element is pepsin, an organic principle closely allied to albumen and fibrin, and which is soluble in water, but insoluble in alcohol. The solvent power consists in the combined action of the pepsin and acid; and an artificial digestion may be effected, if proper heat be maintained (98 to 100°), so as to dissolve albuminous substance. It is this gradual solution of nitrogenous food that goes on in ordinary digestion; it is really more of a chemical than of a vital process, but it is the living action of the stomach that separates the reagents necessary to execute the required

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According to Gmelin and Tiedemann acetic acid is present, and M. Blondlot attributes the acid reaction to superphosphate of lime, -Simon's Chemistry, Sydenham Soc.

the irritability of the stomach may also continue for a considerable period without such effect being produced. It is very common to find aphthous ulceration of the mucous membrane of the mouth; such minute abrasions entirely disappear without leaving any trace, and we believe that a similar state is often present in the stomach, associated with symptoms of irritability, but of a transient character.

Although the characteristic symptoms of inflammatory dyspepsia are sometimes obscured by attendant circumstances, still they are sufficiently diagnostic when considered in their general aspect. Three indications are usually present, whilst others are less constant and of secondary importance. The three signs referred to are, 1, tenderness at the scrobiculus cordis; 2, irritability of the stomach; and 3, a desire for cold drinks.

1. Tenderness at the scrobiculus cordis differs greatly in its intensity, sometimes it is only manifest on pressure or on percussion, at other times it amounts to severe pain passing through to the back between the shoulderblades; in any case, however, pressure at the pit of the stomach is distressing to the patient. In many other diseases, the pain is more severe and persistent, as for instance in ulceration and in cancerous growth, whilst in the one under consideration, it is only described as "soreness."

2. The irritability of the stomach is often disproportionate to the severity of the pain; and the blandest

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